Infertility: Treatment, Procedure, Cost and Side Effects

Intrauterine insemination is a comparatively simpler treatment used for fertility purpose. It is performed without the use of any fertility drugs. In this procedure, the semen is transferred to the uterus by using a thin catheter after a special washing treatment.

There are various reasons which can contribute to the IUI treatment which are mentioned below:

Infertility of males: One of the most prominent reasons for undergoing this procedure is when a male produces low sperm count or have very low motility of sperms.

Presence of hostile cervical mucus

This type of mucus is inappropriate for becoming pregnant. It can occur due to the substance abuse where the adverse effects of drug consumption are prevalent such as infertility producing drugs, imbalance of hormones and other infections. Hostile mucus can be acidic, contain inflammatory cells or antibodies that can cause harm to sperms and may be excessively thick, dry or sticky in physical appearance.

When the sexual intercourse is painful
The complications such as the dryness of vagina, cysts in ovaries and endometriosis (where a female experiences severe pain and cramps during menstruation or ovulation), unusually tight hymen, any cancerous tissue, etc. can be the reasons that make it nearly impossible for her to get pregnant.

Risk factor
A woman is consuming any medications for fertility, and then there is a risk associated with respect to getting pregnant with multiples. The success rate of IUI is affected by several factors which are as following:

• The success rate of IUI becomes 20% higher after performing this procedure each month regularly. But it is further affected by variables such as the cause of infertility, medications used for the same, etc.
• IUI procedure is an invasive and cost-effective choice which makes it less successful than In vitro fertilization.
• The pregnancy is 8 to 17 % successful when a combination of fertility drugs and IUI is used.
• The success of this procedure also depends on the age and of the couple.

Hence you can always have a discussion with your medical health provider before opting for this procedure by keeping in mind the various factors, risk factors and cost involved. In case you have a concern or query you can always consult an expert & get answers to your questions!

Intracytoplasmic Sperm Injection (ICSI) is an artificial procedure similar to IVF. This technique is mostly preferred in case of severe male infertility issues like ejaculatory failure, low sperm count and Azoospermia. ICSI is a refined version of IVF where a single sperm is strengthened and injected into female ova (egg) to initiate conception. The diagnostic and screening process is similar to IVF. ICSI is recommended when:

• The shape of the sperm is abnormal
• The previous IVF cycle fails to produce any fertilized egg. In this scenario, ICSI technique may be used for the next IVF cycle
• The sperm is not strong enough to reach the female egg through natural means
• A male who had vasectomy previously needs sperm to be extracted to fertilize the female egg

ICSI-IVF Procedure:

• Ovarian fertility drugs are given to a woman by an embryologist to produce healthy eggs for fertilization and follicles are examined by ultrasounds and blood tests until eggs get matured.
• Eggs are retrieved from the female ovary with the help of a tiny needle that is attached to the ultrasound probe.
• Fresh sperms are collected on the same day of fertilization and placed in a culture with eggs.
• Each egg is then injected with sperm and left for fertilization.
• The embryo thus formed, if found good enough, is transferred to the uterus through the catheter with ultrasound.

Advantages

• As mentioned earlier, ICSI could help in producing a genetic child even when the male has fertility issues.
• There is a greater chance of fertilization and embryo formation in ICSI compared to IVF.
• The success rates of ICSI and IVF are similar and ICSI can be away when the cause of infertility cannot be determined.

Risks involved

• The side effects in ICSI are similar to those associated with IVF.
• Multiple pregnancies, OHS (Ovarian Hyperstimulation Syndrome) due to stimulating drugs administered for IVF and embryo growth failure.
• Since ICSI requires precision while injecting sperm, there is a rare possibility of damage to the egg if not done carefully.
• The male offspring produced through ICSI may have infertility issues passed genetically.

Some couples have already used ICSI successfully and rate it highly as it is convenient and the possibility of congenital disabilities is minimal. The advantages of ICSI far outweigh the risks involved. In case you have a concern or query you can always consult an expert & get answers to your questions!

Frozen Embryo Transfer or FET is an extremely effective method to conceive a pregnancy. Recent studies have proved that there is a increased chance for pregnancy when the embryos, which get used are frozen and get placed inside the uterus at a time right after the ovaries are stimulated. Still, certain issues can arise with the transfer of frozen embryo, such as:

A Thin Lining of the Uterus
Research has shown that there are not many women who get pregnant if the lining in their uterine does not tend to thicken enough. It is not clear exactly why this problem occurs in most women and moreover there is no sure shot treatment to make the lining of the uterine thick. The experts on fertility would try out different methods like increasing the amount of estrogen or change the way how estrogen is given. There are other instances when women might be given supplemental medicines, while for some, the problem will continue to exist.

What Should Be Done In Case The Problem Persists?

• In case the problem continues for some women, then there are certain approaches which experts might look to adopt. The first one is to cancel the transfer of embryo and try once again at any later stage, that too with a different treatment method.
• The second option which they could think of is to go ahead with the transfer, wherein they might feel that a thin lining does not necessarily mean that it is impossible for a woman to get pregnant but definitely the efficiency would be reduced.
• One last option is to make use of the opportunity for undergoing additional tests which would help them to assess the ability of the uterus to allow implantation of the embryos.

Unexpected Ovulation
For enabling the embryos to get implanted into uterus, placing them very precisely and at the appropriate time is important. This is regarded as the window of implantation. The time taken, is based on the time frame since progesterone reaches the lining of the uterine.

Doctor knows the exact time to place the embryos, right from the time he or she instructs a woman to start having progesterone supplements. In case a woman was to ovulate, the production of progesterone would begin earlier than the normal time and would lead to the shift of the window of implantation. As identifying the correct time of ovulation is almost impossible, so that would lead to some sort of uncertainty into the timing.

Due to this reason, there are doctors who would use medication in order to prevent unexpected ovulation from occurring. Generally an injection called Lupron is usually used as medication.

Timing for the Embryo Transfer is Inappropriate
This is a problem related to early ovulation. There are case when the implantation window is shifted, still the timing of the transfer becomes accurate. Recent studies have shown that quite a nominal percentage of women might have a window of implantation, which could be either earlier or later than normal time. A test called the Endometrial Receptivity Array can help determine at what time is the window of implantation open. In case you have a concern or query you can always consult an expert & get answers to your questions!

It is no longer a secret that, both obese males, as well as females, could be victims of infertility. Estrogen is produced primarily in our ovaries. But more than 30 percent of the estrogen in our body is produced by fat cells. In a normal weight person, the amount of estrogen produced is adequate. 

In an obese person, there will be extra deposits of fat which will be secreting excess estrogen. This estrogen excess interferes with ovulation and causes irregular menstrual cycles. In women who are severely obese (with BMIs ranging from 35-40), the hormonal imbalance becomes so severe that it can cause problems with conception leading to infertility.

List of problems related to obesity and fertility:

• Problems with ovulation
• PCOD Poly cystic Ovarian Disease
• PCOS Poly cystic Ovarian Syndrome 
• Irregular menstrual cycles
• Primary infertility
• Secondary infertility
• Lower success rates for fertility treatments
• Increased risk of miscarriage
• Increased risk of birth defects in babies
• Insulin Resistance 
• Acanthosis nigricans
• Increased risk of gestational diabetes
• Increased risk of preeclampsia
• Hirsutism

Obese men have lower circulating testosterone which affects sperm production known as spermatogenesis. This affects the quantity and quality of a man's sperm. Obese men have increased the risk of oligozoospermia, having fewer than 15 million sperm per milliliter of semen, and far fewer motile sperm than a man of healthy weight. Sperm with high amounts of damaged DNA is significantly more common in obese men than in normal-weight men.[13] Ejaculate volume is also affected. Altered male hormones can also give erectile dysfunction which is the major cause of infertility in obese men. ​

Bariatric surgery - Experience it to believe it!

If Obesity is the root cause of infertility in the males or the females, losing weight is the first step in increasing the chances of fertility. Loss of significant weight leads to a gamete of changes in the hormones, thus resetting the balance as before. In my practice, I have seen the impossible become possible in just a matter of 6 to 12 months after significant weight loss. Couples who have been knocking doors of fertility centers ranging from 3 years of married life till 17 years of married life have yielded excellent results after weight loss surgery/ bariatric surgery. However, I have been very choosy in selecting my cases. By this I mean to choose cases in whom the only reason not to conceive is morbid obesity, wherein all other causes of infertility have been ruled out. Loss of the first 15 to 20 kgs sets the periods back to regularity. In fact now we have to ask the couples to please take precautions to avoid pregnancy until the mother is able to take in adequate quantities of food intake (as it takes few months for the stomach to stretch after bariatric surgery).

In my practice, I have witnessed gratifying results after bariatric surgery in Bangalore in terms of both primary infertility as well as secondary infertility due to Obesity. Be it the sleeve gastrectomy or the gastric bypass.
It is a myth that one can’t get pregnant after bariatric surgery. The other myth is that bariatric surgery affects the intrauterine growth of the baby. For obese mothers who are infertile and also have diabetes, bariatric surgery offers a triple benefit, freedom from obesity, infertility as well as diabetes. In case you have a concern or query you can always consult an expert & get answers to your questions!

Diabetes is often associated with heart diseases. In fact, many people do not know that their kidneys and eyes, too, can be affected due to the increased blood sugar levels. Fertility is often forgotten in this list. Yes, diabetes can lower the fertility rates. In men, it can cause erectile dysfunction and decrease libido. In women, the issues are different. But you should not lose hope if you are a diabetic and want to get pregnant. Controlled sugar levels and healthy body weight can help you become a mother. It should also be understood that diabetes alone cannot be the reason for you not getting pregnant. Several underlying factors such as obesity, polycystic ovary syndrome (PCOS), and irregular periods can be responsible as well.

Diabetes and hormonal disturbances: PCOS results in higher amounts of testosterone, which is the male hormones. This leads to abnormal periods, or at times, the periods are absent in women affected with this disorder. PCOS is often associated with obesity and type 2 diabetes. In women affected by diabetes, the fertility period is lowered. For instance, if a woman without diabetes can conceive up to 40 years, the diabetic woman can conceive up to 34 to 36 years only. This also means that menopause occurs early in such women. Oligomenorrhea and secondary amenorrhea are often connected to type 2 diabetes. It is also seen when these women have a control over their sugar levels, their fertility rate improves.

Type 1 diabetes and fertility: When a woman is affected by type 1 diabetes, mensuration ceases in most cases. Studies indicate that only 2 percent of the women who are affected by type 1 diabetes are able to conceive. While treatment can bring back mensuration in these women, irregular periods cannot be treated successfully. With controlled sugar levels, one can find chances of improved fertility rates. For this, even during the planning period, the woman has to control sugar levels. You can still become pregnant even when you are dependent on insulin. Your requirement dosage can differ. So, check with your primary care provider and gynecologist on the same. Your sugar levels should also be under control throughout your pregnancy.

Type 2 diabetes and fertility: In case of type 2 diabetes, which has begun to develop even in young women, there is a negative impact on the fertility rates. In the past, type 2 diabetes, also known as diabetes mellitus, was common only in the age group of 45 and above. But, lifestyle modifications and food habits have made it common even in the younger age group recently. This has resulted in the lowering of the fertile years and an early advancement of menopause. In women who have hormonal imbalance and diabetes, the combo paves the way to PCOS. Obesity is one of the reasons that trigger both diabetes and PCOS. With additional healthcare, you can become pregnant with diabetes mellitus. A healthy diet plan and exercise routine are recommended by the doctors.

If you are diabetic and planning for pregnancy, ensure that you take proper care to manage blood sugar levels. Enhanced glucose levels can only increase the risk for diabetes in the child. A healthy pregnancy is assured with controlled diabetes.